Approximately 45,000 new head and neck squamous cell carcinomas (HNSCC) are diagnosed
annually in the United States, with at least one-quarter occurring in patients >70 years of age.1,2
Tailoring cancer therapy for older patients with HNSCC can be challenging. Older patients
(herein defined as ? 71 years) with HNSCC often have comorbidities that may hinder their
ability to receive optimal multimodality therapy. While the addition of concurrent chemotherapy
to radiotherapy (RT) is the standard organ preservation approach for locally advanced
HNSCC based upon improved overall survival (OS) in multiple prospective randomized trials, it
can be associated with increased short and long term morbidity compared to RT alone.3-9
Older patients have been underrepresented in prospective clinical trials that have defined
standards of care. In the seminal meta-analysis of chemotherapy in head and neck cancer
(MACH-NC), Pignon et al.10 included 93 randomized trials with over 17,000 patients,
demonstrating an absolute OS improvement of 6.5% at 5 years with the addition of concurrent
chemotherapy (CRT). On subgroup analysis, they noted a decreasing survival benefit of
chemotherapy with age, specifically in patients ?71. However, only 692/17,346 (4%) patients
were >70 years of age.10 Thus, the outcomes of these trials may not be applicable to older
patients. In this study, we used the National Cancer Data Base (NCDB) to evaluate whether the
addition of chemotherapy to RT alone confers an OS benefit in HNSCC patients ?71 years.